Bilateral epididymal sarcoidosis.

OBJECTIVE

To report a case of bilateral epididymal sarcoidosis.

DESIGN

Case report.

SETTING

University hospital.

PATIENT(S): An azoospermic 29-year-old Caucasian male who had had an illness 2 years earlier with acute onset and progressive course of weight loss, fatigue, and cough with painless subcutaneous nodules on the arms, upper thighs, and eyelids.

INTERVENTION(S): Physical examination, scrotal ultrasonography, scrotal magnetic resonance imaging, chest x-ray and computed tomography (CT), urine and semen Ziehl-Neelsen stain, and epididymal/testicular biopsies.

MAIN OUTCOME MEASURE(S): Clinical, laboratory, radiologic, and histopathologic data.

RESULT(S): The patient had bilateral epididymal firm masses with normal sized testes and bilateral enlarged, firm, nonpainful inguinal lymph nodes. Scrotal ultrasonography showed diffuse, bilateral, epididymal enlargement with heterogeneous echo pattern and increased vascularity. Scrotal magnetic resonance imaging revealed diffuse, enlarged epididymis with no focal masses. The chest x-ray revealed prominent hilar shadows, and the chest computed tomography showed mediastinal and hilar lymphadenopathy. Urine and semen Ziehl-Neelsen stains were negative for acid-fast bacilli. Epididymal histopathology revealed multiple noncaseating epithelioid granulomas with concentric arrangement of reticular fibers by reticulin stain.

CONCLUSION(S): Scrotal involvement in sarcoidosis with its variable presentations should be considered.